University Medical Campus Research Articles

Feasibility and Acceptability of Virtual Reality Mindfulness in Residents, Fellows, and Students at a University Medical Campus

ObjectiveTo explore the feasibility, acceptability, engagement, and impact of a virtual reality (VR) mindfulness program for students, residents, and fellows at a university medical campus. Patients and MethodsA total of 30 participants consented to participate in the study from September 13, 2021 to November 12, 2022. They completed a baseline assessment and were trained to use a VR headset to access mindfulness content. Participants were instructed to use the VR mindfulness program 3-5 times per week, or as often as they found helpful, and they completed midline and endline assessments and a semistructured interview about their experience with VR mindfulness. ResultsParticipant engagement in VR mindfulness ranged from 0 to 29 times over 8 weeks. Restricted free time, low portability, and privacy were identified as barriers to use. Participants reported positive experiences with VR mindfulness, especially with the gamified nature of the content. They also reported a desire for increased customization options. Participants’ stress scores decreased, and their mindful awareness and self-compassion scores increased. ConclusionOverall findings support evidence of the feasibility and acceptability of VR mindfulness for college students on a medical campus. Short sessions and variable content may maximize sustained engagement. Implementation efforts should support participant engagement by including training and technological support. Future research should replicate study methods with the addition of a comparison group and should focus on evaluating the efficacy of VR mindfulness in the college student population.

Training in Adolescent Substance and Opioid Misuse in Pediatric Residency Programs.

Nine in 10 adults with a substance use disorder began using substances before age 18.1 Among youth, opioid and polysubstance overdose deaths have increased by 384% and 760%, respectively, since the late 1990s.2 Pediatricians need training in screening, brief intervention, and referral to treatment (SBIRT) for substance use disorders and in medication treatment of opioid use disorder (OUD), all of which are recommended as best practice by the American Academy of Pediatrics (AAP).3–5Pediatric residency training on substance use and opioid misuse is poorly described. The extent to which training relates to regional needs, perhaps most importantly, local overdose death rates, is also insufficiently characterized. We conducted a survey of US pediatric residency programs to assess training in youth substance use and compared findings with regional overdose mortality. We hypothesized that programs located in counties with elevated mortality would be more likely to offer substance use training, but that, overall, the percentage offering such training would be low.We developed an online survey on substance use education that was approved and distributed by the Association of Pediatric Program Directors. The 25-item survey assessed program leadership’s estimated content on substance use and the perceived quality of that training. The survey was distributed by e-mail to pediatric associate program directors from all 201 US pediatric residency programs in March 2019. Associate program directors were surveyed per recommendation by the Association of Pediatric Program Directors and were given the option of forwarding the survey to a faculty member with more knowledge about the curriculum. Results presented in this article are a subset of questions from the survey; the full survey and results are available online (https://hdl.handle.net/2144/41197).Opioid overdose mortality for each program’s county was obtained from the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research.6 Counties were classified as having “high” or “low” mortality relative to the national 2018 age-adjusted mean of 14.6 per 100 000.7Descriptive statistics were used to summarize results, with χ2 analyses to evaluate associations between training and location within high versus low overdose counties. The study was considered exempt by the Boston University Medical Campus Institutional Review Board.Surveys were completed by 120 of 201 programs (60%; Table 1). Ninety-seven programs had county-level overdose data and were included in final analyses. Most programs offered some education on adolescent substance use (n = 80, 82.5%); 77 programs required it and 61 programs offered elective opportunities. Fewer than half provided training inclusive of AAP-recommended SBIRT (n = 40, 41.2%; Table 2).Programs in high-overdose counties were more likely to have education on opioids (including about substance-exposed neonates) as a part of their standard residency curriculum than those in low-overdose counties (79.7% vs 52.6%, P = .005; Table 2). Few programs offered a buprenorphine waiver course (n = 22, 22.5%), although programs in high-overdose counties were more likely to have any residents complete this optional training (22.0% vs 5.3%, P = .03).Overall, 97.5% of programs reported that training about opioid misuse was “important” or “very important,” although just 12.5% rated their overall education on opioid misuse as “good” or “very good.” The main barriers to providing education about adolescent opioid misuse included insufficient faculty expertise (62.8%), curricular time (50.4%), and available content (47.9%). Only 3.3% of programs identified lack of interest as a barrier. All (100%) respondents reported interest in a shared, web-based curriculum on adolescent opioid misuse and related topics.Although most US pediatric residency programs provide education about adolescent substance use, gaps remain, particularly with respect to opioid misuse. Programs in counties with a high opioid overdose burden had more training on OUD, but overall rates of training inclusive of treatment were low. Two AAP-recommended interventions, SBIRT and medications for OUD, were infrequently covered.4,5 Few programs offer education about how to prescribe naloxone, a life-saving intervention for opioid overdose, despite high regional overdose mortality and widespread availability of such training.This study had limitations. The survey collected self-reported data, which may be subject to social desirability bias, and some respondents may have been unaware of the full extent of the training offered.Given that substance use disorders often have their onset in adolescence and that opioid-related mortality among youth is rising, addressing gaps in training for pediatricians should be a priority.

Energy audit and conservation of Dental college – A case study

Power is a lifeline for the industry as well as to the individual citizen. With industrial growth of about 10 %, the power demand is surging very rapidly from last decade. With limited resources of power generation and lack of planning resulted into power shortages throughout the states. Unprecedented powercrisis is hindering the socio-economical growth of almost all states. The remedy for this power crisis is seen by the planner at Centre and states only in the two option. Addition of power capacity. Enforcing disparate load shedding. There is total disregard shown to the time tested option of Energy Efficiency improvement at various stages. (Like in generation, T & D, and end use) Reduction of avoidable energy losses in distribution system. Demand side management. Implementation and Monitoring of Energy efficiency improvement program. Bharti Vidyapeeth University Medical campus, Dhankawadi includes many colleges i.e. Medical, Dental, Rajiv Gandhi Biotechnology, Ayurved, Homeopathy college. Being High Tension consumer having Contract Demand of 200KVA, its monthly average electricity bill is Rs. 6,84,908/-. Sanctioned Demand is 344KVA and connected load is 413kW. Some of the major electricity consuming systems are Illumination, Heating equipment, Water pumping system, Air Compressor, Air conditioners. So, the present paper represents the overview of energy audit and conservation programme carried out at Bharati Vidyapeeth University Dental college campus. This study has resulted in exploring the overall energy and thus cost saving potential of 10 % with simple payback period of months. The outcome of this study and the implementation of the suggestions are discussed with the management and other concerned staff. The suggestions incorporated in Energy Audit report are technically feasible as well as financially viable.

In Case You Haven't Heard…

We're sorry we missed it. An unusual online meeting sponsored by Faegre Drinker Consulting and Arnold Ventures was conducted earlier this month. The June 9 Boston University School of Public Health event focused on what it called “an area ripe for opportunistic fraudsters.” Indeed, we have written about treatment fraud many times. This meeting did note that the SUPPORT Act of 2018 sought to prohibit much of the actions used by those committing substance use disorder treatment fraud but has led to relatively few indictments thus far. There is a human as well as an economic cost to fraud, and focused on the lack of regulation of some programs. It's important to remember that there are bad apples, and that they don't mean all treatment is fraudulent. The focus of this meeting was on using algorithms to detect waste and fraud, something supported by Faegre Drinker and Arnold Ventures and conducted by researchers at the Boston University Medical Campus (the “Drinker,” by the way, is the name of one of the partners of Faegre Drinker Biddle & Reath). The main market for this algorithm is insurance companies. The meeting also focused on secret shopper studies. Brad Sorte of Caron Treatment Centers was there as well and noted that programs that focus on finance instead of patient care — asking about insurance up front, for example — may be fraudulent. Have you ever gone to any health care provider who didn't ask about insurance up front? Still, again, we're sorry to have missed it. (https://www.faegredrinker.com/en/insights/events/2021/6/substance‐use‐disorder‐treatment‐centers‐uncovering‐fraud‐and‐advancing‐policies‐to‐promote‐best‐pra).

Work environment characteristics as determinants of work to family conflict among working females, Egypt.

Positive work environment is the corner stone for control and relief of work to family conflict (WFC). To determine the prevalence work-family spillovers and to study the relations between them and work environment characteristics among full-time female employees at Tanta University Medical Campus. A cross-sectional study was carried among female employees working in the five faculties that are present at Tanta University Medical Campus. A total of 442 female workers were recruited. Data were collected using a self-administered questionnaire including personal characteristics, work-related data, and home responsibilities. Job characteristics scales, work to family, and family to work spillovers scales were used to study their correlation. Participants' mean age was 39.87 ± 10.07 years. Approximately half of participants had moderate degrees of both positive and negative work to family and family to work spillovers. Significant positive correlation was detected between skills discretion and both of positive work to family and family to work spillovers (r = 0.361, r = 0.288, P = 0. 0.001, respectively); similar relations were reported regarding decision authority, coworkers' support, and supervisors' support. The negative work to family and family to work spillovers significantly increased by increasing in work demands (r = 0. 0.315, r = 0.218, P = 0. 0.001, respectively). Significant and negative correlations were found between each of skills discretion and supervisors' support scales and the negative impact of family to work spillover (r = - 0.130; P = 0.006, r = - 0.167; P = 0.001, respectively). The prevalence of both positive and negative work to family and family to work spillovers was relatively high. Significant relations were detected between work-family spillovers and work environment characteristics regarding skills discretion, work demands, decision authority, coworkers, and supervisors' support.

Assessing clinical competency without patients during COVID‐19 pandemic

Surgery is a core curriculum in medical education. During the surgery clerkship in the clinical years, students are expected to acquire sequentially the skill of history taking and physical examination, selecting and interpreting investigations, and choosing the appropriate management for common surgical problems. These skills are the foundation for future medical practice. Such skills will be tested at the end of each clerkship in the surgical ward on real patients. Due to the COVID-19 outbreak, students are forbidden from entering hospital premises. The major problem with this arrangement was - how to assess student's clinical competency outside the hospital? To solve this problem, the examination format was modified for our final year surgery clerkship students. Two sets of documents were prepared before the examination - one set for the student with a history, and the other for the examiner with the history, physical findings, investigations performed, management options, and suggested questions. The questions were composed with a modified “adaptive design” used in online learning - the questions would be changed according to the answer given by a student. The examination was held in a clinical skill and simulation training centre in the university medical campus. Since these students have already acquired the skill of taking history during their earlier years, they were each given a printed history to read before entering the examination room. Each student was tested by two examiners and was first asked to summarize the history and provide differential diagnoses in a professional manner. Each was then asked to describe the essential steps of physical examination and the signs to be elicited. Photos with typical physical findings were shown for interpretation. Knowledge on the appropriate choice and interpretation of investigations as well as management options would then be evaluated. Relevant clinical materials such as laboratory reports, radiological images, endoscopic pictures, and operative specimens were shown. A structured marking scheme was used to provide a platform for objective assessment. All students who took part in the examination were able to understand the instructions clearly. We received no complaint from students. Positive comments were received from the examiners, who were able to have an objective assessment of students' ability in formulating a surgical diagnosis, selecting and interpreting investigations, and suggesting management. Although the examination venue was not hospital-based, having the exam in a simulation ward furnished with medical equipment made the environment resemble the hospital setting. The printed history contained irrelevant surplus information so that each student needed to digest and present a relevant summary to the examiners. Examiners could therefore have a more objective evaluation of the students' ability to pick up important history items. The obvious limitation of this examination format is a lack of assessment of hands-on physical examination skills. However, these were final year students with their physical examination skills tested during their two earlier clerkships. Therefore, the focus on this part of examination was the assessment of their ability to interpret physical signs. The rest of the examination actually mimicked the former bedside examination, namely the selection and interpretation of investigations, and the suggestion of management options. Relevant clinical materials were prepared for elucidation and discussion. The current examination format is similar to the simulation-based educational assessment, which has become a global trend in medical training.1 In conclusion, under the influence of COVID-19, an adapted bedside examination format was carried out to evaluate the clinical skills of medical students. With an increasing number of countries being affected, we believe more medical schools will be facing similar problem and it is not limited to surgical curriculum. In a non-clinical setting, this examination format places more emphasis on the clinical reasoning rather than the actual hands-on skills. Provision of a standardized clinical scenario eliminates biases due to different patient or examiner. Nevertheless, the inability to assess bedside manner and doctor–patient relationship is an inadequacy of this examination format.

Gaussian Mixture Based Uncertainty Modeling to Optimize Energy Management of Heterogeneous Building Neighborhoods: A Case Study of a Dutch University Medical Campus

To realize the goals of energy transition, becoming energy-neutral at the neighborhood level by sharing energy among clusters of heterogeneous buildings with local distributed energy resources (DERs), will play a vital role. However, uncertainties related to demand and renewable sources pose a major operational challenge to schedule the DERs. In this paper, a scenario-based mixed-integer linear programming (MILP) model is proposed for an energy management system (EMS) of a local energy community. The proposed EMS executes a stochastic day-ahead scheduling operation of multi-energy systems (MES). A set of scenarios are generated with the Gaussian mixture model (GMM) to consider uncertainties of demand and renewable sources. Moreover, Monte Carlo simulations (MCS) are performed to assess the effectiveness of the proposed EMS compared to the deterministic one. The proposed method is validated by using a real-world case study of a generic Dutch university medical campus in Amsterdam, the Netherlands. Two types of analysis are performed: one-day analysis and seasonal analysis. In both cases, in an average, the stochastic process outperforms the deterministic process considerably, in terms of cost, CO2 emission, imported electricity from grid and usage of local energy resources.

Abstract A091: Consenting challenges toward age, ethnicity, and co-morbidity matching of cancer patient and control populations at a minority-majority safety net hospital

Abstract Appropriate and diverse representation of minority populations in clinical research studies improves long-term outcomes for all demographics and requires targeted solutions to recruitment challenges. During a two year project at Boston Medical Center (BMC), 191 newly diagnosed, treatment-naïve cancer patients and 76 non-cancer control donors were consented to study relationships between cancer and thrombosis biomarkers. 56% of the cancer patients self-identified as minorities (32% Black, 17% Hispanic, 3% Asian, 4% other or multiple), which reflect the overall demographics of patients undergoing surgery at BMC. However, control donor recruitment for the study was only 36% minorities during the first 6 months (n=9 of 25). These control subjects were younger and white, in part because the study was only advertised on the Boston University Medical Campus. Recognizing potential bias and lack of appropriate representation, two initiatives were developed and executed to balance the cancer and control populations with respect to ethnicity and age. First, active recruitment for older, minority-identifying control subjects expanded into the surrounding community of largely African American and Hispanic populations, by hosting donor recruitment days, with one of the days targeted to older males (≥ 50 years) to better reflect the ongoing cancer patient cohort. Second, consent forms were translated into Haitian Creole and Spanish to enable improved communications with these patients who frequent the hospital. To encourage participation from individuals with a negative perception of research, study coordinators received training in consenting and applied it to provide enhanced patient education. This resulted in a significant improvement in the control’s minority percentage to 64% over the project timeline (n=49, 44% Black, 11% Hispanic, 9% Asian). This approach also helped to balance age distributions in the cancer and control populations. The majority of cancer patients were in their 50s and older (81%, mean 59 ± 12 years; n=155). Control subjects in their fifth decade or above was only 32% in the first 6 months, but improved to 55% (mean 46+ 14 years, n=42) by the end of the project. The study was not designed to match comorbidities, but human immunodeficiency virus (HIV) infection, and hepatitis which are known to affect coagulation are highly prevalent in the BMC population. Of the consented cancer patients, 5% had hepatitis and 2% reported active HIV infection, while in the control population 6% had hepatitis and 5% had HIV. Patient demographic, clinical data, analysis results, follow-up data on treatment and thrombotic events, as well as plasma and cell pellets from this study are freely available to the research community from: cssi.cancer.gov/cancer-thrombosis. Overall, frequent data monitoring and adjusting recruitment strategies to emphasize community outreach contributed to balancing ethnic and age distributions in the study populations during this two year study. Citation Format: Morgan P Thompson, Elizabeth R Duffy, Jasmin H Bavarva, Cheryl Spencer, DJ Stearns-Kurosawa, Rachana Agarwal, Michelle A Berny-Lang, Chris Andry. Consenting challenges toward age, ethnicity, and co-morbidity matching of cancer patient and control populations at a minority-majority safety net hospital [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A091.

Reducing Regulatory Burdens on Research with Human Subjects: A Case Study of the Transition to the Final Common Rule at Boston Medical Center and Boston University Medical Campus

Boston Medical Center/Boston University Medical Campus recently reduced certain requirements for human subjects research where this could be done without adversely affecting the rights and welfare of participants, in anticipation of changes in the Final Common Rule. Modifications affected exempt and expedited categories, approval periods, ceding review, Quality Improvement/Quality Assessment activities, and some requirements for pregnant women, prisoners, and children. This case study may assist other institutions in responding to the Final Common Rule.

Sarcopenia is a Significant Predictor of Mortality After Abdominal Aortic Aneurysm Repair

Repair of abdominal aortic aneurysms (AAA) decreases the incidence of rupture and death. In cancer patients, sarcopenia has been associated with increased surgical complications and mortality. The impact of sarcopenia on survival after AAA repair has yet to be described. Patient demographic, laboratory, body composition measurements and survival data were obtained from patients undergoing AAA repair at the Indiana University medical campus over a 5-year period. Univariate and multivariate analyses were performed to identify factors associated with overall survival. Overall, 58.2% presented with sarcopenia. Sarcopenic patients were older (71.8±8.3 versus 66.8±8.1 years; p<0.001), had lower body mass index (BMI) (26.3±5.2 versus 31.5±5.9 kg/m2; p<0.001), higher rates of myosteatosis (84.4% versus 52.%; p<0.001), greater AAA diameter (60.6±14.0 versus 57.8±11.7 mm; p=0.016), higher Charlson Comorbidity Index (CCI) (32.3% versus 25.1% ≥6; p=0.034), and increased rates of rupture (8.2% versus 3.8%; p=0.047). Sarcopenic and nonsarcopenic patients had no difference in 30-day morbidity (8.5% versus 8.5%; p=0.991) or mortality (3.7% versus 0.9%; p=0.07). Univariate analysis demonstrated age, sarcopenia, myosteatosis, CCI, and BMI to be associated with long-term survival. There was no correlation between BMI and sarcopenia. Both sarcopenia and myosteatosis resulted in decreased one-, three-, and five-year survivals compared to their counterparts. On multivariate analysis sarcopenia is independently associated with survival, conferring a 1.6-fold increase in death (p=0.04). The combination of sarcopenia plus myosteatosis doubled the risk of death compared to sarcopenia alone. This is the first study to demonstrate that over half of all patients undergoing AAA repair are sarcopenic, a condition associated with increased mortality. Sarcopenia with myosteatosis is associated with double the mortality of sarcopenia alone. CT scan, but not BMI, accurately identifies sarcopenia and myosteatosis. Defining the mechanisms through which sarcopenia contributes to late death after AAA repair is critical to developing novel interventions that may improve survival in this high risk population.

Multiple fractures in infants who have Ehlers-Danlos/hypermobility syndrome and or vitamin D deficiency: A case series of 72 infants whose parents were accused of child abuse and neglect.

ABSTRACTObjective: To increase the level of awareness that Ehlers-Danlos/hypermobility syndrome (EDS) and vitamin D deficiency are associated with infantile fragility fractures and radiologic features that may be mistakenly reported to be caused by non-accidental trauma due to Child Abuse and Neglect (CAN).Patients and Methods: We constructed a case series, the largest to date, of infants with EDS who were vitamin D sufficient, insufficient and deficient and infants without EDS but with documented vitamin D deficiency and radiologic evidence of rickets who presented with multiple fractures originally diagnosed as being non-accidental and caused by child abuse. These infants were referred to the outpatient Bone Health Care Clinic at Boston University Medical Campus over a 6-year (2010–2015) period. We also present 6 index cases in which the court concluded that there was no convincing evidence of child abuse and the infants were returned to their parents. Institutional Review Board (IRB) approval was obtained.Results: We present 72 cases of infants with multiple fractures diagnosed to be caused by non-accidental trauma. All infants were younger than one year of age. Among them, 93%(67) had clinical evidence of EDS and/or a family history with a confirmed clinical diagnosis of at least one parent having EDS and the other 7%(5) without evidence of EDS had vitamin D deficiency/infantile rickets. Three of the EDS infants were diagnosed as osteogenesis imperfecta (OI)/EDS overlap syndrome. The most common fractures noted at diagnosis were ribs and extremity fractures (including classic metaphyseal lesions). Serum levels of 25-hydroxyvitamin D [25(OH)D] were reported in 48 infants (18.0 ± 8.5 ng/ml) and in 30 mothers (21.3 ± 11.7 ng/ml). Sixty-three percent (27) of the EDS infants who had their serum 25(OH)D measured were vitamin D deficient 25(OH)D<20 ng/ml and 5 were vitamin D sufficient 25(OH)D>30 ng/ml. The mean serum level for infants with vitamin D deficiency/rickets was (10.2 ± 3.0 ng/ml)Conclusion: EDS, OI/EDS and vitamin D deficiency/infantile rickets are associated with fragility fractures in infants that can be misinterpreted as caused by non-accidental trauma due to child abuse.

Building opportunities for interprofessional education: activities for physical therapy students at a University Medical Campus

Building opportunities for interprofessional education: activities for physical therapy students at a University Medical Campus

The association of injury with substance use disorder among women of reproductive age: an opportunity to address a major contributor to recurrent preventable emergency department visits?

Substance use disorder (SUD) among women of reproductive age is a complex public health problem affecting a diverse spectrum of women and their families, with potential consequences across generations. The goals of this study were 1) to describe and compare the prevalence of patterns of injury requiring emergency department (ED) visits among SUD-positive and SUD-negative women and 2) among SUD-positive women, to investigate the association of specific categories of injury with type of substance used. This study was a secondary analysis of a large, multisource health care utilization data set developed to analyze SUD prevalence, and health and substance abuse treatment outcomes, for women of reproductive age in Massachusetts, 2002 through 2008. Sources for this linked data set included diagnostic codes for ED, inpatient, and outpatient stay discharges; SUD facility treatment records; and vital records for women and for their neonates. Injury data (ICD-9-CM E-codes) were available for 127,227 SUD-positive women. Almost two-thirds of SUD-positive women had any type of injury, compared to 44.8% of SUD-negative women. The mean (±SD) number of events also differed (2.27 ± 4.1 for SUD-positive women vs. 0.73 ± 1.3 for SUD-negative women, p < 0.0001). For four specific injury types, the proportion injured was almost double for SUD-positive women (49.3% vs 23.4%), and the mean (±SD) number of events was more than double (0.72 ± 0.9 vs. 0.26 ± 0.5, p < 0.0001). The numbers and proportions of motor vehicle incidents and falls were significantly higher in SUD-positive women (22.5% vs. 12.5% and 26.6% vs. 11.0%, respectively), but the greatest differences were in self-inflicted injury (11.5% vs. 0.8%; mean ± SD events = 0.19 ± 0.9 vs. 0.009 ± 0.2, p < 0.0001) and purposefully inflicted injury (11.5% vs 1.9%, mean ± SD events = 0.18 ± 0.1 vs. 0.02 ± 0.2, p < 0.0001). In each of the injury categories that we examined, injury rates among SUD-positive women were lowest for alcohol disorders only and highest for alcohol and drug disorders combined. Among 33,600 women identified as using opioids, 2,132 (6.3%) presented to the ED with overdose. Multiple overdose visits were common (mean ± SD = 3.67 ± 6.70 visits). After adjustment for sociodemographic characteristics, psychiatric history, and complex/chronic illness, SUD remained a significant risk factor for all types of injury, but for the suicide/self-inflicted injury category, psychiatric history was by far the stronger predictor. The presence of SUD increases the likelihood that women in the 15- to 49-year age group will present to the ED with injury. Conversely, women with injury may be more likely to be involved in alcohol abuse or other substance use. The high rates of injury that we identified among women with SUD suggest the utility of including a brief, validated screen for substance use as part of an ED injury treatment protocol and referring injured women for assessment and/or treatment when scores indicate the likelihood of SUD.

Abstract A36: Community involvement in prevention research: A model for reducing cancer disparities

Abstract This presentation describes a campus-community partnership established to address cancer disparities in a medically-underserved neighborhood within a large metropolitan urban area. Over the past several decades, the historically African American area has become increasingly isolated and disenfranchised due to demographic changes in surrounding communities. Pilot studies we conducted show higher than expected mortality rates from certain cancers, a high rate of behaviors that increase their risk for cancer (e.g., tobacco use), and a low rate of routine cancer screening and timely access to cancer treatment. As part of our university cancer center's cancer control and community research initiative to decrease local disparities, we created a network of Community Advisory Boards (CAB) throughout our catchment area. The CAB described here was developed to address documented cancer disparities in an area in close proximity to the university's medical campus. We identified community leaders and conducted 20 key informant interviews. With guidance from the CAB, we conducted a door-to-door survey of 250 randomly-selected households in a public housing development to assess community needs related to cancer and barriers to accessing services. A community-based participatory research (CBPR) model was used to engage the community and establish an economic partnership that benefits the community. Benefits include services and employment opportunities. Employing residents as research assistants has been found to maximize recruitment and community acceptance. To date, funded investigations have been conducted on the following: reducing the high prevalence of tobacco use, early detection of oral cancers using biomarkers, stress management for cancer survivors, and screening for conditions related to other chronic diseases such as diabetes. In addition, the university responded to request for services by conducting free annual health screening and education fairs and offering ongoing smoking cessation resources. We will discuss the successes and challenges of this partnership with a community that has minimal infrastructure but is motivated to improve the health of its residents. We will also describe how CAB members are taking ownership of the process and bringing additional resources to the table. Citation Format: Dorothy F. Parker, Tracy Kelley, Eric Thompson, Erin N. Kobetz. Community involvement in prevention research: A model for reducing cancer disparities. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr A36. doi:10.1158/1538-7755.DISP13-A36

Communication and computing technology in biocontainment laboratories using the NEIDL as a model

The National Emerging Infectious Diseases Laboratories (NEIDL), Boston University, is a globally unique biocontainment research facility housing biosafety level 2 (BSL-2), BSL-3, and BSL-4 laboratories. Located in the BioSquare area at the University's Medical Campus, it is part of a national network of secure facilities constructed to study infectious diseases of major public health concern. The NEIDL allows for basic, translational, and clinical phases of research to be carried out in a single facility with the overall goal of accelerating understanding, treatment, and prevention of infectious diseases. The NEIDL will also act as a center of excellence providing training and education in all aspects of biocontainment research. Within every detail of NEIDL operations is a primary emphasis on safety and security. The ultramodern NEIDL has required a new approach to communications technology solutions in order to ensure safety and security and meet the needs of investigators working in this complex building. This article discusses the implementation of secure wireless networks and private cloud computing to promote operational efficiency, biosecurity, and biosafety with additional energy-saving advantages. The utilization of a dedicated data center, virtualized servers, virtualized desktop integration, multichannel secure wireless networks, and a NEIDL-dedicated Voice over Internet Protocol (VoIP) network are all discussed.

Mitochondrial encoded NADH dehydrogenase 5 (MT-ND5) gene point mutation presents as late onset cardiomyopathy

a Cardiovascular Section and Evans Department of Medicine, Boston University School of Medicine, Boston, MA, United States b Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, United States c BUSM Center for Human Genetics, Boston University School of Medicine, Boston, MA, United States d Boston University Medical Campus Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, United States

Dysregulation of miRNAs in AL amyloidosis

Bone marrow plasma cells (BMPCs) were purified using anti-CD138 immunomagnetic beads, from aspirates obtained with permission of the Boston University Medical Campus Institutional Review Board, from patients with immunoglobulin light chain (AL) amyloidosis and from controls. Expression levels of MicroRNAs (miRNAs) were compared by microarray; 10 were found to be increased more than 1.5-fold. These results were confirmed using stem-loop RT-qPCR for the most highly upregulated miRNAs, miR-148a, miR-26a, and miR-16. miR-16, a micro-RNA linked to other hematopoietic diseases, was significantly increased in the AL group at diagnosis, and also in treated patients with persistent monoclonal plasma cells in the bone marrow, but not in patients who achieved a hematologic remission after therapy. miR-16 can be derived from the miR-16-1/mirR-15, a cluster on chromosome 13 or the miR-16-2/miR-15b cluster on chromosome 3. The expression of miR-15b was much higher than miR-15a in both AL and control BMPC, suggesting that miR-16 in plasma cells is mainly derived from miR-16-2/miR-15b. The anti-apoptosis gene BCL-2, a putative target mRNA that can be downregulated by miR-16, was expressed in BMPCs from AL patients, despite elevated levels of miR-16. Our data suggests that miRNAs are dysregulated in clonal plasma cells in AL amyloidosis and may be potentially useful as biomarkers of disease.

Localized amyloidosis of the breast: a case series

We report on the clinical presentation and histopathology of a series of seven patients with localized amyloidosis of the breast. These patients were diagnosed by biopsy performed to rule out malignancy because of calcifications seen by mammography, and represented 0.5% of patients referred to the Amyloid Treatment and Research Program at Boston University Medical Campus in an 18-year period. The patients ranged in age from 35 to 75, median 63 years. None of these seven patients had evidence of a systemic plasma cell dyscrasia or amyloidosis in other organs, nor did systemic disease develop with a median follow-up of 6 years. Thus, other than excisional biopsy to exclude malignancy, no systemic therapy is indicated for this disorder.

Self-assembly of Glut4 Storage Vesicles during Differentiation of 3T3-L1 Adipocytes

Glut4 storage vesicles (GSVs) represent translocation-competent vesicular carriers in fat and skeletal muscle cells that deliver Glut4 to the plasma membrane in response to insulin stimulation. GSVs include three major cargo proteins: Glut4, insulin-responsive aminopeptidase (IRAP), and sortilin. Previous work has suggested that the lumenal interaction between Glut4 and sortilin and the cytoplasmic interaction between sortilin and GGA adaptors play an important role in recruitment of Glut4 into the GSVs. However, the mechanism of IRAP targeting to this compartment remains unknown. To address this question, we show that in differentiating adipocytes IRAP enters the GSVs from the "donor" membranes on day 3 of differentiation. Forced expression of sortilin in undifferentiated cells does not recruit IRAP into the vesicles. However, double expression of sortilin and Glut4 reconstitutes functional GSVs that incorporate endogenous IRAP. To explain this process, we show by a yeast two-hybrid system and chemical cross-linking that the lumenal domain of IRAP can interact with the lumenal loop of Glut4. IRAP without the lumenal domain is faithfully targeted to the donor membranes but has significantly lower insulin responsiveness than full-length IRAP. We suggest that lumenal interactions between Glut4 and IRAP play an important role in the assembly of the GSVs.

Follow-up study of the use of refrigerated homogenous bone transplants in orthopaedic operations : Philip D. Wilson MD (1886-1969). The 3rd president of the AAOS 1934.

Philip Duncan Wilson was born in Columbus, Ohio. His father was a family physician who held the Chair of Obstetrics in the Sterling Medical School [1]. The young Philip graduated from Harvard College in 1909 and then served as President of his graduating class at Harvard Medical School. He spent two years as a surgical intern at MGH, after which he returned to Columbus to practice. During WWI he was invited back to Boston to join the Harvard Unit under Harvey Cushing, and served with that unit when it was housed in the Lycée Pasteur. (The members of that unit included Marius Smith-Petersen, who also spent many years at the Massachusetts General Hospital and also became AAOS President.) He rejoined MGH on the staff in 1919. In 1925 he published an influential monograph with W.A. Cochrane (formerly of the Edinburgh Royal Infirmary), entitled, “Fractures and Dislocations” [5].Toward the end of his years in Boston he helped found the American Academy of Orthopaedic Surgeons. In 1934 he was appointed as Surgeon-in-Chief at the Hospital for the Ruptured and Crippled in New York City. Dr. Wilson was active in many organizations, and reorganized and renamed the hospital he served (Hospital for Special Surgery), oversaw the building of a new hospital at its current site on the Cornell University medical campus, and raised money for a large research building. His zest inspired generations, and he was known for his gracious hospitality.Dr. Wilson was one of three of the first fifteen Presidents (the others being Drs. John C. Wilson, Sr. and Melvin Henderson) whose son (Dr. Philip D. Wilson, Jr.) succeeded him as a President of the American Academy of Orthopaedic Surgeons.Dr. Wilson had a long interest in bone grafting and wrote numerous research papers, a few of which are referenced here [2–4]. In the article reprinted in this issue [3], he described the rapid increase in use of a bone bank he developed at the Hospital for Special Surgery in 1946: 19 operations using grafts in 1946, 48 in 1947, 106 in 1948, 134 in 1949, and 259 in 1950. He describes his animal experiments with autogenous grafts in which grafts rapidly incorporated. He further describes biopsies of previously implanted autogenous and homogenous bone transplants in patients undergoing serial fusions for scoliosis. The pathologist (Dr. Milton Helpern) commented they found “...no evidence that the cells in the bone transplants survived...” Autogenous grafts, his evidence suggested, incorporated more rapidly that homogenous grafts, but “...in the end the results are the same.” His followup studies suggested successful incorporation of graft in 210 of 248 cases. Philip Duncan Wilson, MD is shown. Photograph is reproduced with permission and ©American Academy of Orthopaedic Surgeons. Fifty Years of Progress, 1983.ReferencesPhilip Duncan Wilson, MD 1886–1969. J Bone Joint Surg Am. 1969;51:1445–1447.Wilson PD. Experiences with a bone bank. Ann Surg. 1947;126:932–945.Wilson PD. Experience with the use of refrigerated homogenous bone. J Bone Joint Surg Br. 1951;33:301–315.Wilson PD. Follow-up study of the use of refrigerated homogenous bone grafts in orthopaedic operations. J Bone Joint Surg Am. 1951;33:307–323.Wilson PD, Cochrane WA. Fractures and Dislocations. Philadelphia, PA: JB Lippincott; 1925.